Three- Dimensional Evaluation of Similarity of Right and Left Knee Joints

장기모,박종훈,장민호,김영준,이덕희,박세형,왕준호 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

Purpose: The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. Materials and Methods: Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. Results: No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of <1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. Conclusions: There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee.

In Vivo Three-Dimensional Imaging Analysis of Femoral and Tibial Tunnel Locations in Single and Double Bundle Anterior Cruciate Ligament Reconstructions

양재혁,장민호,곽대순,장기모,왕준호 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.1

Background: Anatomic footprint restoration of anterior cruciate ligament (ACL) is recommended during reconstruction surgery. The purpose of this study was to compare and analyze the femoral and tibial tunnel positions of transtibial single bundle (SB) and transportal double bundle (DB) ACL reconstruction using three-dimensional computed tomography (3D-CT). Methods: In this study, 26 patients who underwent transtibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft. 3D-CTs were taken within 1 week after the operation. The obtained digital images were then imported into the commercial package Geomagic Studio v10.0. The femoral tunnel positions were evaluated using the quadrant method. The mean, standard deviation, standard error, minimum, maximum, and 95% confidence interval values were determined for each measurement. Results: The femoral tunnel for the SB technique was located 35.07% ± 5.33% in depth and 16.62% ± 4.99% in height. The anteromedial (AM) and posterolateral (PL) tunnel of DB technique was located 30.48% ± 5.02% in depth, 17.12% ± 5.84% in height and 34.76% ± 5.87% in depth, 45.55% ± 6.88% in height, respectively. The tibial tunnel with the SB technique was located 45.43% ± 4.81% from the anterior margin and 47.62% ± 2.51% from the medial tibial articular margin. The AM and PL tunnel of the DB technique was located 33.76% ± 7.83% from the anterior margin, 45.56% ± 2.71% from the medial tibial articular margin and 53.19% ± 3.74% from the anterior margin, 46.00% ± 2.48% from the medial tibial articular margin, respectively. The tibial tunnel position with the transtibial SB technique was located between the AM and PL tunnel positions formed with the transportal DB technique. Conclusions: Using the 3D-CT measuring method, the location of the tibia tunnel was between the AM and PL footprints, but the center of the femoral tunnel was at more shallow position from the AM bundle footprint when ACL reconstruction was performed by the transtibial SB technique.

요골두 금속 치환물의 국내 사용

문준규,박종웅,한상환,장기모 대한견주관절의학회 2007 대한견주관절학회 학술대회논문집 Vol.2007 No.5

생체 모방형 3차원 세포 프린팅 기술을 이용한 골/연골 재생

심진형,박주영,한세광,정현태,김기문,장기모,왕준호,조동우 대한기계학회 2013 대한기계학회 춘추학술대회 Vol.2013 No.5

시멘트형 Polished Versys HeritageⓇ 대퇴 스템의 2-5년 추시 결과

손원용,허창룡,문준규,한상환,양재혁,장기모 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though contemporary cementing techniques have improved results. Versys Heritage femoral stem was used with a contemporary cementing technique to determine the outcome of using a polished surface. Materials and Methods: Between October 2000 and August 2003, 131 primary hybrid hip arthroplasty procedures were performed in 117 patients. The mean age at the time of the index arthroplasty was 52 years and 9 months (24-78 years). The average follow up period was 49 months (range, 24-71 months). All the hips were evaluated clinically by the Harris hip score and radiologically by the cement grade, osteolysis as well as stress shielding. Results: At the final follow up, the Harris hip score for all patients had improved from preoperative 59.1 (range, 17-91) to post operative 92.8 (range, 78-100). The cement grade was measured using Barrack's method. Of 131 hips, 75, 54 and 2 were grade A, grade B and grade C1 at the final follow up, respectively. None of the hips showed a C2 or D grade. There was no evidence of aseptic loosening or osteolysis on the femoral side during follow up. 45% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Conclusion: In this study, the Polished Versys Heritage femoral stemⓇ showed excellent results at the short to mid term follow up period. However, a longer-term follow-up study will be needed to clarify the implications of the femoral prosthesis surface finish or design.

동시에 발생한 양측성 슬개골 소매형 골절 -1례 보고-

임홍철 ( Hong Chul Lim ),문준규 ( Jun Gyu Moon ),양재혁 ( Jae Hyuk Yang ),장기모 ( Ki Mo Jang ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.2

Sleeve fractures of the patella are cartilaginous avulsion fractures from the lower pole of the patella. They occur mainly due to sports injuries in adolescents. They may be missed in diagnosis due to rare incidence and small bony fragment on simple radiographs. In this report, an unusual bilateral simultaneous sleeve fracture in a healthy child is described.

요골두 금속 치환물의 국내 사용

한상환(Sang-Hwan Han),문준규(Jun-Gyu Moon),박종웅(Jong-Wong Park),장기모(Ki-Mo Jang) 대한견주관절의학회 2007 대한견주관절의학회지 Vol.10 No.1

Poorer dynamic postural stability in patients with anterior cruciate ligament rupture combined with lateral meniscus tear than in those with medial meniscus tear

이진혁,Dae-Hee Lee,Jong-Hoon Park,Dong Won Suh,Eunseon Kim,장기모 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background: Only limited data are available regarding postural stability between anterior cruciate ligament (ACL)-injured patients with medial meniscus (MM) tear and those with lateral meniscus (LM) tear. The purpose of this study was to compare preoperative postural stability for both involved and uninvolved knees in ACL rupture combined with MM and LM tears. It was hypothesized that there would be a significant difference in postural stability between these two groups. Methods: Ninety-three ACL-injured patients (53 combined with MM tears vs. 40 combined with LM tears) were included. Static and dynamic postural stability were evaluated with the overall stability index (OSI), anterior–posterior stability index (APSI), and medial–lateral stability index (MLSI) using stabilometry. Knee muscle strength was evaluated using an isokinetic testing device. Results: In the static postural stability test, none of the stability indices showed significant differences between the two groups for both knees (p > 0.05). In the dynamic postural stability test for involved side knees, the OSI and APSI were significantly higher in the LM tear group compared to the MM tear group (OSI: 2.0 ± 0.8 vs. 1.6 ± 0.5, p = 0.001; APSI: 1.5 ± 0.6 vs. 1.3 ± 0.5, p = 0.023), but not the MLSI (p > 0.05). In the static and dynamic postural stability tests in each group, there were no significant differences between the involved and uninvolved side knees (p > 0.05). There was no significant difference in the knee muscle strength between the two groups (p > 0.05). All postural stability showed no significant correlation with knee muscle strength (p > 0.05). Conclusion: Dynamic postural stability was poorer in patients with ACL rupture combined with LM tear than in those with MM tear. Therefore, close monitoring for postural stability would be necessary during preoperative and postoperative rehabilitation, especially for patients with ACL rupture combined with LM tear.

60세 이상 노년층에서의 자발성 슬관절 골 괴사증

임홍철(Hong Chul Lim),노경선(Kyoung Sun Noh),양재혁(Jae Hyuk Yang),장기모(Ki Mo Jang) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.5

목적: 60세 이상 노년층에서의 자발성 슬관절 골 괴사증의 병변의 크기와 진행시기에 따른 치료의 결과에 대해 분석하고자 한다. 대상 및 방법: 2000년 1월부터 2004년 6월까지 60세 이상의 환자로 자발성 슬관절 골 괴사증으로 진단받고 추후 경과 관찰이 가능하였던 19명(슬관절 22예)의 환자를 대상으로 하였으며 추시 기간은 평균 20.7개월이었다. 병변의 크기는 슬관절 전후면 단순 방사선 사진에서 병변의 대퇴과에 대한 비율(대퇴과 율, condylar ratio) 및 전후면 사진과 측면 사진에서의 크기를 곱한 값으로 측정하였으며, 단순 방사선상 질환의 진행 시기를 분류하였고 각각의 시기에서 병변의 크기를 측정하여 대퇴과 율이 40% 이하이면서 병변의 면적이 5.0 cm2 이하인 경우 보존적 치료를 시행하였으며, 대퇴과 율이 40% 이상이거나 면적이 5 cm2 이상인 경우 슬관절 반 치환술 또는 슬관절 전 치환술을 시행하였다. 통계적 분석 방법으로 T-테스트, 스피어만 분석법 및 윌콕슨 분석법을 사용하였다. 결과: 성별은 여성(15명 79%)에서 많았으며, 발생부위는 좌우 슬관절에 차이가 없었으나 양쪽 슬관절을 침범한 경우가 3명에서 있었다. 대퇴내과(21예 95%)에서 대부분 발생하였으며, 병변의 크기는 대퇴과 율이 40% 이내인 경우가 7예(31%), 40% 이상 이환된 경우가 15예(69%)이었다. 방사선 분류상 1, 2기인 5예에서는 보존적 치료를 시행하였고 치료 전후 knee score의 차이는 없었다(ρ=0.931). 3, 4기인 17예에서 보존적 치료를 시행한 7예에서는 치료 후 knee score의 유의한 감소를 보인 반면 인공 관절 치환술을 시행한 10예에서는 knee score의 유의한 증가를 보였다(p>0.005). 결론: 60세 이상 노년층에서의 자발성 슬관절 골 괴사증은 적절한 치료를 위해 정확한 진단과 병변의 크기, 진행시기를 정확히 파악하는 것이 중요하다. 1, 2기의 골괴사에서 보존적 치료시 증상의 진행은 없었으나 진행된 3, 4기의 골괴사는 인공 관절 치환술을 시행함으로써 보존적 치료비하여 보다 만족스러운 결과를 가져올 수 있으리라 사료된다. Purpose: This study examined the results of treatment according to the stage and size of a spontaneous osteonecrosis lesion of the knee (SONK) in the patients over 60 years of age. Materials and Methods: Twenty-two knees from 19 patients over 60 years of age were treated for spontaneous osteonecrosis of the knee at our institution between January, 2000, and June, 2004. The mean follow time was 20.7 months. The condylar ratios, proportion of the lesion size to the condyle were measured. The size was obtained by multiplying the values from the anteroposterior and lateral radiographs. The stages were classified radiographically, and the treatment results were analyzed according to the size and stage. Conservative treatment was performed if the ratio and size were <40% and 5.0 cm2, respectively. Arthroplasty was performed if the ratio or size was >40% or 5.0 ㎠. A paired T-test, Spearman correlation test and Wilcoxon test were used for the statistical evaluation. Results: There was a higher prevalence in females (15 patients, 79%), and the mean age was 65 years (46-77 years). Bilateral involvement was observed in 3 patients. The lesions involved mainly the medial femoral condyle (21 cases, 95%). Seven cases (31%) had a condylar ratio <40% and 15 cases (69%) had a condylar ratio >40%. Conservative treatments were performed in 5 cases staged radiographically as I or II and there were no significant changes in the knee scores (ρ=0.931). Of the 17 cases staged III and IV radiographically, conservative treatment and arthroplasty were performed in 7 and 10 cases, respectively. Seven cases, in whom conservative treatments had been performed, showed a decreased in the knee scores compared with the increased knee scores in 10 patients treated with arthroplasty (ρ=0.943). Conclusion: An accurate diagnosis and measurement of the size and staging of spontaneous osteonecrosis of knee in patients over 60 years of age is important for proper treatment. Clinically, no further progression of symptoms is visible on grade I and II spontaneous osteonecrosis of the knee after conservative treatment. However, arthroplasty improves the clinical results in patients with radiological grade III and IV osteonecrosis compared with conservative treatment.

시멘트형 Polished Versys Heritage<SUP>®</SUP> 대퇴 스템의 2-5년 추시 결과

손원용(Won-Yong Shon),허창룡(Chang-Yong Hur),문준규(Jun-Gyu Moon),한상환(Sang-Whan Han),양재혁(Jae-Hyuk Yang),장기모(Ki-Mo Jang) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 현대 시멘트 기법을 이용한 인공 고관절 전치환술 후 대부분의 결과는 우수한 것으로 보고되어 있으나, 아직도 대퇴 스템의 표면 처리에 대해서는 논란이 많이 있다. 저자는 polished Versys Heritage 대퇴 스템을 이용한 인공 고관절 전치환술에 대한 결과를 보고하고자 한다. 대상 및 방법: 2000년 10월부터 2003년 8월까지 131고관절(117명)에 cemented Versys Heritrage 대퇴 스템을 이용하여 인공 고관절 전치환술을 시행하였다. 117명의 환자 중 남자는 81명, 여자는 36명이었으며 수술시 연령은 최소 25세에서 78세였고 평균 연령은 52.9 세였다. 평균 추시 기간은 49.2개월(24-71개월)이었고, 임상적 결과는 Harris Hip Score 및 대퇴부 동통 유무를 이용하여 평가하였으며 방사선학적 평가에 있어서는 Barrack 등의 시멘트 등급과 대퇴 스템 주위의 해리 및 대퇴 근위부의 stress shielding을 평가하였다. 결과: 술후 마지막 추시 임상적인 평가에서 Harris hip score는 평균 59.1점(17-91점)에서 평균 92.8점(78-100점)으로 향상되었다. 방사선학적 평가에서 Barrack 등의 시멘트 등급은 A 등급 75예, B 등급 54예, C1 등급 2예였다. 추시기간동안 방사선학적 대퇴 스템 이완의 소견을 보였던 예는 없었으며 전예에서 골용해 소견은 관찰되지 않았고 약 45%에서 Engh의 1 및 2 등급의 응력 방패 현상이 관찰되었다. 결론: 시멘트형 polished Versys Heritage 대퇴 스템을 이용한 인공 고관절 전치환술에서 24-71개월 추시에서 우수한 결과를 보였다. 그러나 향후 장기적인 추시가 필요하리라 사료된다. Purpose: Surface finishing of a cemented femoral stem is a subject of controversy even though contemporary cementing techniques have improved results. Versys Heritage femoral stem was used with a contemporary cementing technique to determine the outcome of using a polished surface. Materials and Methods: Between October 2000 and August 2003, 131 primary hybrid hip arthroplasty procedures were performed in 117 patients. The mean age at the time of the index arthroplasty was 52 years and 9 months (24-78 years). The average follow up period was 49 months (range, 24-71 months). All the hips were evaluated clinically by the Harris hip score and radiologically by the cement grade, osteolysis as well as stress shielding. Results: At the final follow up, the Harris hip score for all patients had improved from preoperative 59.1 (range, 17-91) to post operative 92.8 (range, 78-100). The cement grade was measured using Barrack's method. Of 131 hips, 75, 54 and 2 were grade A, grade B and grade C1 at the final follow up, respectively. None of the hips showed a C2 or D grade. There was no evidence of aseptic loosening or osteolysis on the femoral side during follow up. 45% of stems showed grade 1 and 2 stress shielding according to Engh's criteria. Conclusion: In this study, the Polished Versys Heritage femoral stem<SUP>®</SUP> showed excellent results at the short to mid term follow up period. However, a longer-term follow-up study will be needed to clarify the implications of the femoral prosthesis surface finish or design.